TRICARE Medicare Eligible Program Second Generation (TMEP2)

This solicitation seeks a contractor to provide end‑to‑end claims processing, customer support, and associated administrative services for dual‑eligible Medicare‑TRICARE beneficiaries across the United States and its territories. The effort is a firm‑fixed‑price, 8‑year contract (12‑month transition‑in, seven 1‑year option periods, 12‑month transition‑out, and a possible 6‑month extension). The contractor must operate an automated claims processing system, maintain integration with DEERS and other DoD health‑information systems, run a 24/7 call center, manage provider verification, handle electronic funds transfer, and deliver performance metrics per TRICARE manuals. Small‑business participation is encouraged, with a minimum 3 % goal. • Process and adjudicate Medicare‑TRICARE claims for active‑duty families, retirees, reservists, survivors, and former spouses. • Provide 24/7 call‑center and portal‑based customer service (6 AM‑11 PM ET, 365 days). • Maintain and update automated claims system to reflect policy changes, OHI coordination, and catastrophic caps. • Interface with DEERS, DMDC, and DHA provider files; verify provider eligibility and manage participation agreements. • Deliver electronic remittance advice (ERA) and EFT payments in HIPAA‑compliant format. • Submit required data to Medicare Bundled Payment Initiatives and other reporting mandates. • Manage transition‑in, transition‑out, and optional 6‑month extension activities with minimal service disruption.